- Total Bilirubin Is Associated with Small Intestinal Bacterial Overgrowth in Diarrhea Predominant Irritable Bowel Syndrome. [Journal Article]
- ACAnn Clin Lab Sci 2019; 49(3):344-352
- CONCLUSIONS: These findings suggest that total bilirubin levels may provide additional information regarding the presence of SIBO in diarrhea-predominant IBS patients.
- Berberine improves intestinal epithelial tight junctions by upregulating A20 expression in IBS-D mice. [Journal Article]
- BPBiomed Pharmacother 2019 Jul 11; 118:109206
- To investigate effects of berberine exerts on A20 expression and regulation of intestinal epithelial tight junctions via the TNF-α-NF-κB-MLCK pathway in Diarrhea-Predominant Irritable Bowel Syndrome …
To investigate effects of berberine exerts on A20 expression and regulation of intestinal epithelial tight junctions via the TNF-α-NF-κB-MLCK pathway in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D). C57BL/6 wild type (WT) and A20 IEC-KO mice (48 each) were randomly divided into normal control (NC), model control (MC), rifaximin and berberine groups (12 mice per group). An experimental model of IBS-D was established using 4% acetic acid and evaluated by haematoxylin-eosin (HE) staining. rifaximin and berberine mice were treated with rifaximin and berberine, respectively. Intestinal epithelial space of WT berberine mice improved more than A20 IEC-KO berberine mice compared to MC mice. WT berberine mice exhibited greater expression of A20 compared with MC mice(P < 0.01). TNF-α, NF-kB p65, MLCK, MLC, TRAF6 and RIP1 levels in A20 IEC-KO and WT berberine mice were all decreased compared to MC mice(P all<0.05). NF-κB p65, MLCK and TRAF6 levels were increased in A20 IEC-KO berberine mice as compared to WT berberine mice (P all<0.05). Intestinal epithelial levels of occludin, claudin-1, ZO-1 and F-actin increased in all berberine mice (P all<0.01-0.05), while occludin, claudin-1, and ZO-1 levels were lower in A20 IEC-KO berberine mice(P < 0.05). Berberine downregulates abnormal activation of the TNF-α-NF-κB-MLCK pathway by upregulating expression of A20 in a mouse model of IBS-D, thereby protecting intestinal epithelial tight junctions and repairing the damage IBS-D causes to the intestinal epithelial barrier.
- Efficacy of long-term rifaximin treatment for hepatic encephalopathy in the Japanese. [Journal Article]
- WJWorld J Hepatol 2019 Jun 27; 11(6):531-541
- CONCLUSIONS: Rifaximin therapy improves overt HE. The long-term use of rifaximin in the Japanese is effective and safe.
- The efficacy and safety of rifaximin-α: a 2-year observational study of overt hepatic encephalopathy. [Journal Article]
- TATherap Adv Gastroenterol 2019; 12:1756284819858256
- CONCLUSIONS: The addition of rifaximin-α to lactulose treatment was associated with a significant reduction in the number and length of HE-related hospitalizations for overt HE. Rifaximin-α treatment was well tolerated.
- Seizure Disorder Exacerbated by Hepatic Encephalopathy: A Case Report. [Case Reports]
- OAOpen Access Maced J Med Sci 2019 May 31; 7(10):1669-1671
- CONCLUSIONS: Though uncommon, hepatic encephalopathy should be considered in patients presenting with convulsions, especially if there is a known history of liver disease. Until the underlying liver issues are addressed, patients may not respond to traditional anti-convulsant therapy for their seizures.
- Precipitating Factors and Treatment Outcomes of Hepatic Encephalopathy in Liver Cirrhosis. [Journal Article]
- CCureus 2019 Apr 02; 11(4):e4363
- Background Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with liver cirrhosis (LC). The aims of this study were to evaluate the precipitant factors and analyze the t…
Background Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with liver cirrhosis (LC). The aims of this study were to evaluate the precipitant factors and analyze the treatment outcomes of HE in LC. Methods All the LC patients admitted between February 2017 and January 2018 for overt HE were analyzed for precipitating factors and treatment outcomes. Treatments were compared among three treatment groups: receiving lactulose, lactulose plus L-ornithine L-aspartate (LOLA), and lactulose plus rifaximin. The primary endpoints were mortality and hospital stay. The chi-square test was used to compare the different treatment outcomes with hospital stay and mortality with significance at p<0.05. Results A total of 132 patients (mean age 49.2 ± 10.2 years; male/female ratio of 103:29) were studied. The most common precipitating factor of HE was infection 65 (49.2%), followed by electrolyte imbalance 54 (41%), constipation 44 (33.33%), and gastrointestinal bleeding 21 (16%) patients. At the time of admission, 29 (22%), 76 (57.5%), 21 (16%), and six (4.5%) patients had grade I, II, III, and IV HE, respectively. The difference in mortality was not statistically significant (p=0.269) in three groups but the hospital stay was shorter among patients in groups B and C than in group A alone (7.36 ± 4.58 and 7 ± 3.69, 9.64 ± 5.28 days, respectively, p=0.015). Conclusions Infection, especially spontaneous bacterial peritonitis, was the commonest precipitating factor of HE. The combination of lactulose either with LOLA or rifaximin is equally effective in improving HE and reducing the duration of hospital stay than lactulose alone.
- Nosocomial Infections Are Frequent and Negatively Impact Outcomes in Hospitalized Patients With Cirrhosis. [Journal Article]
- AJAm J Gastroenterol 2019; 114(7):1091-1100
- CONCLUSIONS: NIs are prevalent in hospitalized patients with cirrhosis and are associated with poor outcomes. Although higher MELD scores and systemic inflammatory response syndrome are associated with NI, all hospitalized patients with cirrhosis require vigilance and preventive strategies.
- Change in antimicrobial susceptibility and PCR ribotypes of Clostridioides difficile in a hospital over 5 years: Correlation analysis with antimicrobial consumption. [Journal Article]
- IJInt J Antimicrob Agents 2019 Jun 05
- Clostridioides difficile infection (CDI) is a major concern in hospital settings. Antimicrobial resistance is a key contributing factor in CDI outbreaks. This study analysed the antimicrobial suscept…
Clostridioides difficile infection (CDI) is a major concern in hospital settings. Antimicrobial resistance is a key contributing factor in CDI outbreaks. This study analysed the antimicrobial susceptibility and PCR ribotypes (RTs) of 745 C. difficile isolates collected at a single institution over 5 years. Seventeen known RTs were identified in 643 isolates (86.3%), of which RTs 018, 017, 015, 001 and 002 were the most prevalent. Reduced susceptibility to metronidazole (MTZ) and vancomycin (VAN) was rare (2.0% and 0.7%, respectively). Resistance to rifaximin (RFX), moxifloxacin (MXF) and clindamycin (CLI) was high in multiple RTs (29.3%, 67.0% and 69.4% of total isolates, respectively). Antimicrobial susceptibility varied among RTs. Whilst non-susceptibility to VAN, RFX, MXF, CLI and piperacillin/tazobactam (TZP) mostly occurred in commonly identified RTs, MTZ resistance was observed in diverse RTs. Correlation analysis between the MICs of the six antimicrobials for annual isolates and antimicrobial consumption in the hospital by year showed variable degrees of correlation; significant positive correlation for TZP (P = 0.037), significant negative correlation for VAN (P < 0.001) and no significant correlation for the other antimicrobials. MIC creep of TZP occurred during the study period with the appearance of 19 isolates with TZP intermediate-resistance mostly in 2013 (89.5%; 17/19), and three RTs containing TZP-intermediate-resistant isolates, including RT015 (n = 4), RT002 (n = 12) and RT112 (n = 1), increased over time (P = 0.010). These findings suggest an association of antibiotic consumption and resistant C. difficile strains and question TZP use for limiting CDI in hospitals.
- Rifaximin reduces the incidence of spontaneous bacterial peritonitis, variceal bleeding and all-cause admissions in patients on the liver transplant waiting list. [Journal Article]
- APAliment Pharmacol Ther 2019 Jun 06
- CONCLUSIONS: Rifaximin prescribed for HE in patients listed for liver transplantation improved outcomes with significant reduction in admissions related to spontaneous bacterial peritonitis, ascites and variceal bleeding.
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- Shiga toxin-induced haemolytic uraemic syndrome and the role of antibiotics: a global overview. [Review]
- JIJ Infect 2019; 79(2):75-94
- CONCLUSIONS: It appears that, while some antibiotics such as b-lactams and TMP/SMX may be detrimental, others appear to be safe and can prevent the development of HUS. Of note, fosfomycin appears to be the antibiotic with the most positive results from clinical studies, and may be able to avert HUS development, especially if administered within the first two or three days from diarrhoea onset. Fluoroquinolones have also shown positive outcomes in clinical studies, despite demonstrating unfavourable results in in vitro studies. Other agents, such as colistin, gentamycin and rifamycins, have shown promising results in in vitro studies and require further evaluation.